As a good proportion of the population has grown up during the post-mumps vaccine era--which began in 1949--there is concern about its reappearance and the risk it confers. What bears emphasis is that mumps is not one of the horseman of the apocalypse, even if it is capable of sidelining several hockey players. As I have written before, severe complications of mumps, such as meningitis, are rare, more common in adults, and recovered from uneventfully (even those who experience meningitis).

Mumps resurgences are due to waning immunity coupled with the exposure pressure inherent in closed populations such as college dormitories or hockey locker rooms. While even I probably have waning immunity to mumps, I don't have much exposure pressure and certainly am not party to "saliva spray". As such, mumps doesn't represent a significant public health threat at this time.

The diagnosis of mumps, a nationally notifiable disease, is usually based upon seeing the classic facial appearance. Confirmation is made either by looking for antibodies to the virus, growing the virus, or detecting the genetic material of the virus. Antibody tests may be hard to interpret in a previously vaccinated person who has a breakthrough infection and may be falsely negative (as seems to be the case with Crosby); other tests may prove more useful in that setting.

Another concern is the contagiousness of mumps. While it is a minor illness, it is important to try and delimit spread. Mumps is spread through direct contact with respiratory secretions and people are contagious 2 days prior and 5 days after salivary gland swelling. I can imagine a hockey player locker room being strewn with snot, spit, and other secretions--a perfect playground for mumps.

The case in Pittsburgh has caused some added concern because another Penguin being investigated for mumps visited a hospital. Since mumps is not airborne, it is not clear that a major risk of transmission existed and even if significant exposures occurred, the consequences, if any, will be minimal as vaccination uptake is high amongst the population.

Though I enjoy it when there's general interest in any infectious disease, a recalibration of threat perception is needed: we are likely in for a rough flu season and that is of much greater concern than hockey player's faces morphing into those of chipmunks.